Irregular menstruation: A cause of concern?

Have you ever faced a change in the duration of your menstrual cycle, even when you are neither pregnant nor close to menopause? 

You are having what is called irregular periods when the menstrual cycle is outside of your regular duration. The menstrual cycle may last for 21 to 35 days, and the flow usually happens for two to seven days. 

In the beginning, long cycles are common, which become shorter and more regular as the person ages. Each person has a duration that is normal to her, and if that changes, she may be suffering from irregular periods.

Let's get one thing straight. An irregular period doesn't automatically mean something is wrong. 9-14 per cent of women normally have irregular periods between menarche and menopause. It may be part of growing up (e.g., puberty) or a result of stress. 

Starting on hormonal contraceptives can also cause disturbances in the period. This usually goes away after a few months.

However, sometimes irregular periods are related to something more serious. Polycystic ovary syndrome, or PCOS, is an important reason for irregular periods, as is eating disorders associated with severe weight loss (e.g. bulimia and anorexia nervosa). 

Endometriosis, when cells grow abnormally within the uterus, may also manifest as irregular periods. Excessive exercise, pelvic inflammation and some types of uterine tumours can also cause this.

Hormonal problems, as in thyroid disorders, can make the periods irregular. Other causes of irregular periods include uncontrolled diabetes, hormone-secreting tumours and Cushing's syndrome.

Closer to menopause, the cycle usually becomes irregular. However, there is a note of caution: uterine cancer risk increases with age. So, any irregular period close to menopause must be investigated properly.

To understand the periods properly, it is important to keep track of the cycles. This will help better identify if something is different from the regular cycles. So, what things to take note of? 

Definitely, how long the period is, whether the bleeding is light or heavy, if there is any in-between bleeding, other associated symptoms (e.g. pain) and anything else that seems important.

If you have irregular periods, you can give it a few months. Sometimes the period becomes regular without any issues. Dr. Laura Callanan of Rochester Regional Health, New York, states, "Chronic abnormal bleeding is diagnosed after irregular menstrual cycles have persisted for at least six months." 

She said her first suggestion to her patients is to monitor this for three months, especially if the irregularity is something entirely new, and get concerned if it persists for at least six months.

But there are some things that necessitate seeking care immediately. 

For example, if your period length is frequently less than 21 days or more than 35 days, you have severe menstrual pain, your bleeding suddenly becomes heavy, the difference between your shortest and longest period is >20 days or when the irregular period is associated with your inability to get pregnant despite trying to do so. 

However, it is best to talk to a physician when you are suffering from irregular periods just to be on the safe side.

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